Headache is so common that almost everyone gets one at some point. The great majority of headaches are benign and settle with self-care. A doctor's job is to spot the few situations where the pain is a sign of something serious, and to help when recurring headaches get in the way of life.
The two most common: tension-type headache and migraine
Tension-type headache is the most common form. It feels like pressure or tightness, often like a band around the head, on both sides. The pain is mild to moderate and does not get worse with ordinary movement. Nausea is not usually part of it. Behind it there is often stress, poor sleep, tension in the neck and shoulders, or a long working day at a screen.
Migraine comes in attacks. Untreated, an attack typically lasts 4–72 hours. The pain is often one-sided and throbbing, moderate to severe, and worse with exertion. Nausea and sensitivity to light and sound are common. In some people the attack is preceded by an aura, for example zigzag flickering in the field of vision or numbness in a hand, which lasts under an hour and then passes.
Both are unpleasant, but neither damages the brain. The same person can have both, and then it is worth learning to tell them apart, because the treatment differs.
Medication-overuse headache is easy to miss
If you need painkillers several days a week, the medicine itself can start to keep the headache going. Rule of thumb: simple painkillers such as paracetamol or anti-inflammatory medicines on fewer than 15 days a month; triptans and combination painkillers on fewer than 10 days a month. If you keep going over that limit, raise it with a doctor.
Self-care
- A regular rhythm: sleep, meals and enough fluids at roughly the same times every day. Migraine does not like change.
- Exercise regularly and take breaks from screen work.
- Caffeine: keep the amount steady; cutting down suddenly causes headaches.
- At the start of an attack, take a painkiller as the package leaflet directs straight away, and rest in a dark, quiet room.
- A headache diary: note the days, duration, medicines and possible triggers. It is the most valuable information you can give a doctor.
When a doctor's assessment is worthwhile
- attacks are frequent, for example several days a month, or interfere with work
- over-the-counter medicine does not work, or you need it on more than 10 days a month
- the headache has changed in character or is getting worse over weeks
- a new headache starts in someone over 50
- you are pregnant and the headache is new or worse than usual
A doctor can start migraine attack medication such as a triptan, assess whether preventive medication is needed, write a sick leave certificate where appropriate, and refer you to a neurologist if the problem is not resolved at primary-care level. When migraine has already been diagnosed, continuing the medication can often be handled remotely.
Go to the emergency department or call 112 immediately if
- the pain starts like a thunderclap and within seconds or minutes is the worst of your life
- the headache comes with fever and a stiff neck, or a rash of small bleeding spots that do not fade when pressed
- there are stroke-like symptoms: one-sided weakness or numbness, slurred speech, loss of vision, double vision. In that case call 112 immediately, even if the symptom passes.
- you are confused, unusually drowsy or have a seizure
- the pain started after a blow to the head, especially if you take blood-thinning medication
- the pain is worst in the morning or lying down and comes with vomiting
- you are pregnant and the headache comes with visual disturbances, swelling or high blood pressure
In these situations time matters. Do not start with a remote service.
How Treat can help
If your headaches keep coming back or you are unsure what kind they are, you can describe your symptoms in Treat in your own words. A licensed doctor usually assesses the situation within minutes during service hours and tells you whether self-care is enough, whether medication is needed or whether you should be examined in person. Treat is not an emergency service: with any of the warning signs above, call 112.
This article is general health information and does not replace an individual assessment by a doctor.